Dangerous combinations in chemsex: GHB and alcohol, poppers and Viagra, protease inhibitors…

Why are combinations so dangerous?

In chemsex, people rarely take just one drug. But two substances can add up (two depressants slowing breathing), cancel each other out (a stimulant masking a depressant until it wears off) or interact with medicines. Sexosafe clearly advises avoiding drug/alcohol mixes.

Combinations to avoid at all costs

GHB/GBL + alcohol

AIDES is categorical: completely incompatible. Even a beer drunk a while before can be enough to cause poisoning, and most reported comas involve alcohol + GHB/GBL. No alcohol before, during or after (GHB).

GHB/GBL + sedatives

According to AIDES: benzodiazepines (Valium, Xanax, etc.), pregabalin (Lyrica), sleeping pills (zolpidem, zopiclone), opioids, some anti-epileptics: higher risk of respiratory depression. The same applies to ketamine with these drugs.

Poppers + Viagra, Cialis and co.

Drogues Info Service advises against combining poppers with erection drugs: both dilate blood vessels, which can cause a sudden drop in blood pressure, fainting or even a heart attack. Poppers + alcohol also makes headaches, dizziness and fainting more likely.

Cathinones (3-MMC…) + protease inhibitors

Drogues Info Service warns of a risk of fatal overdose when cathinones are combined with protease inhibitors (HIV treatments boosted with ritonavir or cobicistat) (3-MMC).

GHB + protease inhibitors

AIDES says protease inhibitors raise blood levels of GHB/GBL: risk of overdose, doses must be reduced.

Methamphetamine + MAOI antidepressants, alcohol, MDMA

Drogues Info Service cites a risk of hypertension and serotonin syndrome with MAOIs, increased toxicity with alcohol and adverse reactions with MDMA or LSD (crystal).

Stimulants together

Stacking cathinones, cocaine, crystal, MDMA: overheating, racing heart, stroke risk. And when a stimulant wears off, GHB taken “to balance it” can suddenly hit on its own.

On medication?

If you live with HIV, take PrEP or another medicine (antidepressant, anti-anxiety drug), talk to your doctor or a charity: interaction checkers exist and there are often treatments without interactions. Nobody will judge you. AIDES also notes that drug use can disrupt adherence to treatment.

If someone collapses

Unconscious or breathing badly: recovery position, call emergency services (112, 15 in France), never leave them alone. Tell the paramedics what was taken: it can save a life.